                     AIDS Daily Summary 
                       June 09, 1994


The Centers for Disease Control and Prevention (CDC) National AIDS
Clearinghouse makes available the following information as a public
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Copyright 1994, Information, Inc., Bethesda, MD

"City, State, 4 HMOs Join to Keep Betak Open"
Philadelphia Inquirer (06/09/94) P. B1;  Collins, Huntly
     In a move to save Philadelphia's only exclusive AIDS nursing home
from immediate closure, the city, state, and four health 
maintenance organizations agreed to donate more than $200,000 to 
help Betak meet its payroll at least through next month.  The 
news brought an end to the 17-day hunger strike of a handful of 
activists who protested the nursing home's potential closing.  
After July, officials expect to fashion a permanent solution to 
the facility's financial woes, including the possibility of a new
owner for the 43-bed home.  Lutheran Home, which has been 
subsidizing Betak, is plagued by its own financial troubles, and 
says it can no longer underwrite the facility's $2.8 million 
annual budget.
      
"The Renaissance Man as Radical"
Philadelphia Inquirer (06/09/94) P. F1;  Collins, Huntly
     Kiyoshi Kuromiya, the 51-year-old editor of "Critical Path," a 
newsletter that dispenses treatment information to some 9,500 
people, is the liaison that bonds hundreds of AIDS advocates in 
Philadelphia.  Despite his own HIV infection, Kuromiya is 
unflagging in his efforts.  A founding member of ACT UP, he runs 
a computer bulletin board for AIDS patients and operates a 
"community medicine chest," a supply of recycled drugs retrieved 
from the cabinets of patients who have died or switched to other 
drugs.  Kuromiya also uses his own personal phone number as a 
24-hour AIDS hotline--which receives calls from all over the 
country, at all hours of the day.  He is also one of a handful of
activists who sit on the government's AIDS Clinical Trials Group,
a network of 1,200 scientists, doctors, and other professionals 
who oversee federally sponsored trials of experimental AIDS 
drugs.
      
"Landmark AIDS Trial Jury Deliberates"
United Press International (06/08/94)
     The first jury ever asked to decide whether AIDS discrimination 
is a breach of federal law continues deliberations today in the 
case of a Fremont, Ohio, hospital accused of violating the 
Americans with Disabilities Act by refusing to admit an AIDS 
patient.  A lawyer representing the estate of Fred Charon asked 
the Toledo federal jury to order Fremont Memorial Hospital and 
the admitting physician to pay $1 million in damages, while 
attorneys for the hospital and for Dr. Charles Hull maintained 
that Charon received the best possible medical care with his 
transfer from Fremont to Medical College Hospital in Toledo.  
Hull admitted to saying "... once you get an AIDS patient, you'll
never get him out," but said he meant only that a seriously ill 
AIDS patient could die in a small community hospital not equipped
to treat the disease.
      
"Columbia Laboratories Signs U.S. Agreement With Lake 
Pharmaceutical to Market Its Newest Product, Advantage 24"
Business Wire (06/08/94)
     Columbia Laboratories Inc., a U.S.-based pharmaceutical firm, has
signed a letter of intent with Lake Pharmaceutical concerning 
marketing of its Advantage 24 product, a sustained-release 
contraceptive gel.  Columbia intends to grant Lake Pharmaceutical
exclusive U.S.-marketing rights of Advantage 24, whose benefits 
include slow-release characteristics that allow the spermicide to
remain effective for up to 24 hours.  Considering Lake's 
distribution capabilities, Columbia president and CEO Norman M. 
Meier said the gel would be widely available by the end of 1995, 
and would be "positioned to fully benefit when studies 
demonstrate the effectiveness of Advantage 24 on the prevention 
of chlamydia and the AIDS virus."
      
"The First Search for the Source"
Toronto Globe and Mail (06/08/94) P. A16;  Mickleburgh, Rod
     Hospitals in Canada, where more than 1,000 blood transfusion 
recipients became infected with HIV, announced on Monday that 
they intend to track down everyone who received the procedure 
from 1978 to 1985, when the Red Cross began to screen donated 
blood for the virus.  Under the trace-back procedure, when a 
blood transfusion patient develops HIV, the patient's hospital 
gives the Red Cross the code numbers of blood units donated to 
the patient.  The Red Cross then tries to contact all of the 
involved donors to urge them to undergo HIV testing.  This method
is largely based on protocol developed in 1985, according to Col.
Neville Robinson.  As administrator of Vancouver's Red Cross 
Blood Transfusion Center, Robinson led that year's investigation 
into the source of HIV-contaminated blood that infected two blood
transfusion recipients.  Operation 300, as it was called, was 150
days spent trying to contact the 301 donors to the first infected
patient and the 17 donors linked to the second patient.  The 
detective work meant hours of telephone work at a time when fear 
of AIDS had gripped the public.
      
"Good News and Bad News About AZT"
U.S. News & World Report (05/16/94) Vol. 116, No. 19, P. 88
     Recent studies with AZT have brought both triumph and 
disappointment to the AIDS battle.  In a recent trial of AZT in 
HIV-positive, pregnant women, scientists at the National 
Institutes of Health calculated that those who took the drug were
only one third as likely to transmit the virus to their babies as
were those who took a placebo.  Another finding, however, 
suggests that while AZT has demonstrated clear benefit to most 
patients who are already sick, the common practice of prescribing
AZT before a patient exhibits symptoms of disease does not 
ultimately prolong life.  In fact, according to the study, the 
side effects from taking the drug--including chronic nausea and 
fatigue--may outweigh its short-term benefits.  The finding has 
left HIV patients in a "catch-22" situation: either to cope with 
the side effects of taking AZT in order to delay sickness, or to 
wait before taking the drug, possibly bringing illness on 
earlier.  A panel of experts convened by the National Institutes 
of Allergy and Infectious Diseases suggests that AZT use be 
dictated by CD4 levels.  Those with counts under 200 should take 
the drug.  Patients with counts between 200 and 500 should 
consult a physician.  And those with CD4 counts over 500--about 
half the normal level--should not take AZT, says the panel.
      
"Zidovudine for the Prevention of HIV Transmission From Mother to
Infant"
Journal of the American Medical Association (05/25/94) Vol. 271, 
No. 20, P. 1567
     Although preliminary results of a trial of zidovudine to prevent 
HIV transmission from mothers to their babies showed a 67.5% risk
reduction, the findings were subject to at least four 
limitations.  First, the study did not measure the efficacy of 
zidovudine among women whose T cell counts were below 200.  Nor 
did it assess the efficacy of zidovudine among women who had 
previously used the drug for extended periods and may have 
developed zidovudine-resistant strains of HIV.  The study also 
did not evaluate risk in the first trimester of pregnancy.  
Third, the study failed to assess the independent or relative 
contributions of  the antepartum, intrapartum, or treatment of 
the infant; therefore, the efficacy and side effects of 
zidovudine regimens restricted to only one or two of these 
treatment periods were unknown.  Finally, the study has not yet 
yielded any information about long-term side effects for the 
infants and mothers treated with zidovudine.
      
"Suppression of HIV Production in Resting Lymphocytes by 
Combining Didanosine and Hydroxamate Compounds"
Lancet (05/21/94) Vol. 343, No. 8908, P. 1292;  Malley, Serge D.;
Grange, Jacques M.;  Hamedi-Sangsari, Farid et al.
     Although the currently available AIDS drugs zidovudine, 
didanosine, and zalcitabine exhibit strong HIV inhibition in 
vitro in long-term dividing cell lines and activated peripheral 
blood mononuclear cells, they are only partially effective in 
suppressing viral replication in AIDS patients.  Malley et al. 
suggest that it is the non-dividing "resting" cells that should 
be targeted for antiviral activity, since quiescent peripheral T 
lymphocytes may be an important and inducible HIV reservoir in 
infected persons.  The researchers evaluated the anti-HIV 
activity of the three drugs and found them, alone or in 
combination, unable to fully inhibit viral production or protect 
the cells from the cytopathic effect of viral replication.  The 
drugs were then tested in combination with hydroxamates, known 
for their inhibitory effect on ribonucleotide reductase in 
replicating cells.  Didanosine in combination with '-hydroxamate 
(DAH) or hydroxyurea (HU) yielded a synergistic effect resulting 
in complete suppression of viral production, total protection 
against the cytopathic effect induced by viral replication, and 
non effect on the cells' ability to replicate normally after 
treatment.  Trials are slated for May.
      
"Bereavement Reactions"
Focus (05/94) Vol. 8, No. 6, P. 7;  Neugebauer, R.;  Williams, 
J.B.W.;  Rabkin, J.G. et al.
     New York City researchers who interviewed 84 HIV-negative and 123
HIV-positive gay and bisexual men in 1988 and 1989 found no 
connection between loss and depressive symptoms for either 
serostatus group.  Participants were subjected to medical, 
psychiatric, and psychosocial examinations.  Half of the group 
had experienced at least one loss since the onset of the 
epidemic; more than 20 percent had suffered a loss within the six
months prior to the interview.  Neither level of depressive 
symptoms nor rate of diagnosed depressive disorder was linked to 
the number of losses the subject had endured.  This lack of 
association held for both seropositive and seronegative men, and 
held on three different depression scales.
      
"HIV Vaccine Trials: Will Intravenous Drug Users Enroll?"
American Journal of Public Health (05/94) Vol. 84, No. 5, P. 761;
Meyers, Kathleen;  Metzger, David S.;  Navaline, Helen et al.
     A number of HIV vaccines are currently in phase I/II clinical 
trials, and as this work progresses towards phase III studies, a 
relevant practical question emerges.  As of yet, little work has 
been done to outline the issues surrounding recruitment and 
retention of volunteers for HIV vaccine trials.  Crucial is the 
need to determine whether individuals at high risk, particularly 
intravenous drug users, will participate.  To assess the 
willingness of addicts to participate in vaccine trials, Meyers 
et al. analyzed the results of questionnaires completed by 257 IV
drug users.  The subjects were asked about risk behaviors, 
interest in vaccine trials, and other vaccine-related 
information.  Meyers et al. discovered that 30 percent of the 
subjects did not even know what a vaccine was.  Of those that 
did, however, 52 percent expressed willingness to be one of the 
first to participate in a preventive HIV vaccine trial.  
Twenty-two percent, however, said they would probably increase 
needle-sharing if they were vaccinated.  The findings suggest 
that some in-treatment drug users would enroll for preventive HIV
vaccine efficacy trials, but that education and counseling would 
be required to make sure participants fully understand the 
trial's purposes, methods, risks, and benefits.
      
